Rheumatology
The Discipline
Rheumatology is the subspecialty of internal medicine that focuses on the diagnosis and treatment of medical diseases of the joints, muscles, and connective tissues. Although traditionally thought of as dealing primarily with joint diseases such as arthritis, physicians trained in rheumatology (“rheumatologists”) possess expertise in evaluating and managing a wide spectrum of disorders related to the musculoskeletal system, including systemic inflammatory and autoimmune diseases that may also involve other organ systems. Although many musculoskeletal and related soft tissue diseases are treated by general internal medicine physicians and other specialty physicians, rheumatologists are frequently called upon to help in diagnosing and managing more complex and systemic disease.
Examples of conditions cared for by rheumatologists include rheumatoid arthritis, osteoarthritis, crystalline diseases (such as gout), the spondyloarthropathies, vasculitis (such as giant cell arteritis or polyarteritis nodosa), polymyalgia rheumatica, systemic lupus erythematosus, inflammatory muscle diseases (such as polymyositis and dermatomyositis), systemic sclerosis (scleroderma), Sjögren disease, polychondritis, osteoporosis, fibromyalgia, and common musculoskeletal and sports injuries.
There are many different models of rheumatology practice. Rheumatologists may have their own practice, seeing patients in consultation for other physicians and longitudinally for management of their rheumatic disease. Rheumatologists also frequently serve as hospital consultants for patients admitted with rheumatological disorders. Some rheumatologists maintain practices seeing a mix of patients with rheumatological issues and those with general medical problems. In academic settings, rheumatologists provide consultative and ongoing care in ambulatory and inpatient settings, perform basic science and clinical research in rheumatological diseases, and teach medical students and residents.
Training
Fellowship training in rheumatology is two years following completion of a three-year basic internal medicine residency. Following completion of a rheumatology fellowship, board certification is available through the American Board of Internal Medicine.
Dual certification in both rheumatology and allergy and immunology is also available and requires a minimum of three years of training beyond the three-year basic internal medicine residency. Completion of this combined fellowship allows for board certification in both rheumatology and allergy and immunology.
Training Positions
In this 2024-2025 academic year, there were 133 Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs in Rheumatology with 584 trainees.
Major Professional Societies
- American College of Rheumatology
- American College of Allergy, Asthma, & Immunology
See all the career pathways open to internal medicine physicians. Be sure to also explore a day in the life of an IM specialist/subspecialist.
Back to the August 2024 issue of ACP IMpact